Management of open fractures

Open fractures (GXH) is one of the most common surgical emergencies. The proper assessment of the extent of injury and the appropriate indications of management are important, helping patients recover quickly and preserve the position of the injured bone.

Assess the extent of open fractures

(Photo: TTO)

When the bone is broken, sharp tips can stab from inside to outside, causing soft to heavy damage to the software, causing bleeding. However, to assess injury and determine the direction of treatment is not simple, 30% of open fracture victims are multi-trauma, many life-threatening coordinated injuries, must prioritize emergency care. Usually to remember, people order 3 uppercase letters A, B, and C.

Airway: Is the airway obstructed?

Breathing: Do you have pleural bleeding due to fracture of mobile ribs that makes it difficult to breathe?

Circulation: Is there a dynamic or venous injury that causes acute and excessive blood loss?

Bleeding in GXH may be caused by skin damage, muscle, fracture causing bleeding, may also be due to artery, venous veins, leading to a loss of blood loss, attention must be paid to the above three emergency levels. The consequences of GXH are infection, non-bone, bone loss, loss of function causing disability, damage and costly treatment. Prognosis of GXH depends not only on fracture status but also on the vulnerability of the software. World medicine currently classifies GXH according to the following types:

Type 1: Open fractures with clean wounds, length less than 1cm, usually caused by stabbing bones from the inside out.

Type 2: GXH has torn the software larger than 1cm, skin is peeled but not crushed.

Type 3: is the heaviest type, can be divided into 3 small groups.

The software is larger than 10cm due to strong shock.

Severe contamination, due to rubbing on the ground, injury in places susceptible to infection such as ranches, sewers, was rescued after 8 hours.

There are vascular lesions, requiring emergency vascular sutures, reconstructive surgery. Injuries due to fire, landmines, or large fractures caused by traffic accidents are particularly severe.

Management measures

When encountering these cases, the first thing is to stop bleeding properly, to give priority to shock prevention in severe cases, infusion, fix the wound and immediately transfer to the medical facility so that the patient can emergency.

Surgery is a measure applied to social security. The goal is to clean the wound, if there is good anesthesia and depending on the condition, the patient can deal with multiple injuries once, avoiding anesthesia many times. The surgery is also to cut the broken parts and clean the wound, open nerves, blood vessels, and bones are covered with neighboring skin flaps. But it is not advisable to sew the skin right away to prevent the damage to the air and to treat the wound well after a few days to close the wound. If it is suspected that the wound is not clean, it can be cleaned with a little antiseptic solution to the software, the whole body needs intravenous high dose antibiotic, tetanus vaccination.

The fixation of fracture bone should not generally use the type of medullary nails, screw braces. External fixation means that the complex fracture bone fixation, infection prevention, release of joints is the recommended method for trauma specialists. However, the type of external fixation is too complicated, it should not be used in emergencies but use side supports, to easily take care of wounds, tissue regeneration with skin flaps covering important software.

Although there are many positive measures to treat GXH, there is still an imperfect result rate: staggered, spindle, bone loss, false joints, classic non-bone infection . The patient may be hospitalized with multiple injuries, coma, visceral rupture, spinal fractures with GXH. Patients need multi-trauma care, nutrition, post-operative rehabilitation, and other consequences must be addressed in many subsequent stages.

In war, GXH is a common problem, while in peace, this injury is mostly caused by traffic accidents. Therefore, preventing GXH is not more important than ensuring safety when participating in traffic. If unfortunately you encounter GXH trauma, quickly bring the victim to the medical facility for timely management. 

GS. DUONG DUC BINH